Payer Roundup—North Carolina pays out $6B in Medicaid contracts

FierceHealthcare | February 06, 2019

North Carolina officials have reached agreements with five insurers to offer Medicaid managed care in the state, with the deals totaling $6 billion. The insurers—AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, UnitedHealthcare, WellCare and Carolina Complete Health, a consortium of Centene Corp. and state provider groups—will be paid a flat fee per beneficiary per month and can share in profits if costs are kept low but will face a loss if costs run over. It’s the largest amount ever spent by the state’s Department of Health and Human Services. The updated Medicaid program will be rolled out in geographical phases. North Carolina also rejected a proposal from the state’s 12 largest health systems to run its Medicaid program, much to the frustration of patient advocates. “I was very surprised that the hospitals’ bid was rejected, and that two plans that have no real North Carolina experience and bad track records in other states were accepted instead,” said Douglas Sea, senior attorney at the Charlotte Center for Legal Advocacy.

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The American Health Information Management Association (AHIMA), HIMSS and Integrating the Healthcare Enterprise (IHE) International published “Health IT Standards for Health Information Management Practices,”


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HEALTH TECHNOLOGY

Northwell Health and Aegis Ventures Launch Ascertain – Healthcare AI Company Creation Platform to Improve Quality and Access to Care

Northwell Health | April 13, 2022

Northwell Health, New York’s largest healthcare provider, and Aegis Ventures, a New York-based startup studio announced at their inaugural Healthcare AI Innovation Summit the finalization of definitive agreements to launch Ascertain, a joint company creation platform. Ascertain is a first-of-its-kind partnership that pairs a dynamic venture studio with one of the nation’s largest and most impactful health systems to develop and commercialize breakthrough healthcare AI companies that improve quality and access to care and close health equity gaps. Ascertain represents a novel, more targeted approach to the way entrepreneurs and healthcare systems collaborate to solve major healthcare challenges. The platform combines clinical and business leadership, expert technical and product teams, access to Northwell’s leading, diverse datasets, and capital resources within a single ecosystem – with a sole focus on building and validating effective solutions that can be rapidly brought to market. “Ascertain brings a unique structure, an innovative approach, and a compelling vision to create breakthrough healthcare AI companies that are set up for success. We are all driven by the idea that everyone deserves access to high-quality, affordable healthcare. Our aim is clear: to find new, cost-efficient ways to create and accelerate companies that deliver real, equitable solutions.” Michael Dowling, President and CEO of Northwell Health Ascertain has commenced the creation of its first portfolio companies in partnership with Northwell’s clinicians and administrators. One such collaboration is focused on bringing substantive improvements in maternal health, working hand-in-hand with Northwell’s recently launched Center for Maternal Health to develop new approaches to detecting and managing serious complications for expectant mothers and babies. Ascertain’s data science team has been working hand-in-hand with Northwell’s Maternal and Fetal Medicine team to examine tens of thousands of cases of preeclampsia, a hypertensive pregnancy complication that disproportionately affects Black mothers in the United States. Using cutting-edge data science techniques, the Ascertain team aims to deliver an AI solution that helps clinicians predict the risk of developing preeclampsia, enabling them to intervene earlier than previously possible. “Existing approaches to the detection of preeclampsia often occur too late in pregnancy, once the condition has begun to manifest. An important enabler for a solution to this challenge is predictive analytics, applying available knowledge of a patient's history to enable action far earlier with simple, yet life-saving, clinical interventions. We believe the AI solution Ascertain is currently developing will enable this,” shared Burt Rochelson, MD, Chief of Maternal Medicine at Northwell Health. “Aegis and Northwell’s multidisciplinary teams are pursuing innovation through a systematic approach that will bring validated solutions to patients more quickly and at a lower cost,” said Bill Schoenfeld, Aegis Ventures Chairman. “Our skillsets are extraordinarily complementary and enable us to address healthcare’s most entrenched quality, equity, and cost problems far more powerfully than either organization could alone.” Ascertain is preparing to launch multiple companies in 2022 that focus on maternal health, chronic disease detection and management, and next-generation AI tools. Ascertain’s Chairman Tom Manning shared, “Together, we’re paving a new way forward, a monumental step toward real, proven AI solutions that can bring impact to the world. It is a bold collaboration to drive AI-backed companies that save lives and resolve long-standing health inequities – and realize results that deliver something greater in healthcare.” Ascertain is committed to building exceptional teams that will embrace this unique opportunity to create unparalleled impact. To learn more about Ascertain or register your interest, please visit https://ascertain.com/. About Ascertain Ascertain is a revolutionary new partnership between Northwell Health, New York’s largest healthcare provider, and Aegis Ventures, a dynamic startup studio. This unique partnership assembles leading medical, technology, and business resources to create a first-of-its-kind company creation platform for healthcare innovation to address healthcare’s most challenging quality, equity, and cost problems. Ascertain brings $100M in seed-stage capital to bear in pursuit of a three-pronged approach to company creation: internal ideation, commercialization of scientific breakthroughs, and US market entry partnerships for global ventures. Ascertain creates companies that improve quality of care, patient experience, and long-standing health, placing patient needs at the center of every business model, technology solution, and product. About Northwell Health Northwell Health is New York State’s largest healthcare provider and private employer, with 23 hospitals, 830 outpatient facilities and more than 16,600 affiliated physicians. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 77,000 employees – 18,900 nurses and 4,800 employed doctors, including members of Northwell Health Physician Partners – are working to change healthcare for the better. We’re making breakthroughs in medicine at the Feinstein Institutes for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Nursing and Physician Assistant Studies. About Aegis Ventures Aegis Ventures is a next-generation startup studio that partners with entrepreneurs and industry leaders to originate, launch, and scale transformative companies. Our platform brings together market-shaping ideas, permanent growth capital, and ambitious individuals driven to solve major societal problems. We aim to build companies with the capacity for vast impact, with an initial focus on artificial intelligence and digital health. Within these verticals, Aegis seeks to create companies that leverage technology to better optimize tradeoffs between quality, access, and cost, focusing on innovations that promote seamless continuity of care, patient empowerment, and better-informed clinical decision-making.

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FUTURE OF HEALTHCARE

Change Healthcare and Optum Extend Merger Agreement

Optum | April 06, 2022

Optum, a diversified health services company, and Change Healthcare a health care technology leader, have agreed to extend their merger agreement to December 31, 2022. “The extended agreement reflects our firm belief in the potential of our combination to improve health care, and in our commitment to contesting the meritless legal challenge to this merger.” In a joint statement, the companies Change Healthcare and Optum share a vision for achieving a simpler, more intelligent and adaptive health system for patients, payers and providers. The combination of Optum and Change Healthcare will connect and simplify the core clinical, administrative and payment processes health care providers and payers depend on to serve patients. Increasing efficiency and reducing friction will benefit the entire health system, resulting in lower costs and a better experience for all stakeholders. Change Healthcare and Optum will detail the benefits of this combination at a two-week trial scheduled to begin on August 1. The U.S. Department of Justice’s attempt to block the combination is without merit and serves only to delay improving the experience and outcomes for all participants in the health system. As part of the extension, Optum will pay a $650 million fee to Change Healthcare in the event the merger is unable to be completed because of the court’s decision. Change Healthcare will pay a special cash dividend of $2.00 per share to its shareholders at or about the time of the closing. About Optum Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 190,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group. About Change Healthcare Change Healthcare is a leading healthcare technology company focused on insights, innovation, and accelerating the transformation of the U.S. healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient-engagement outcomes in the U.S. healthcare system.

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MEDICAL DEVICES

Extremity Medical Files Patent Infringement Lawsuit Against Nextremity Solutions, Zimmer Biomet Holdings and Zimmer, Inc.

Extremity Medical, LLC | April 07, 2022

Extremity Medical, LLC, a global medical device company focused on the development of innovative implants and instruments for upper and lower extremities, announcedthat it filed a lawsuit against Nextremity Solutions, Inc.; Zimmer Biomet Holdings, Inc.; and Zimmer, Inc., alleging infringement of an Extremity Medical patent* for its intraosseous fixation platform arising from the marketing of the InCore® Lapidus System by these companies. The complaint was filed in the U.S. District Court for the District of Delaware. Extremity Medical has amassed an intellectual propertyportfolio that includes 49 patents in the U.S. and several foreign countries. The novel and patented technology of Extremity’s intraosseous fixation platform provides surgeons with a zero-profile solution for fusion and fixation of bones within the upper and lower extremities, with the ability to be implanted through minimal incisions. This technology is currently marketed globally by Extremity under the trade names IO FiX, IO FiX Plus, IO FiX 2.0, IO Freedom, CarpalFiX, ApeX and XMCP. “Extremity Medical has invested a tremendous amount of effort and resources in research and development to create innovative technology to improve the lives of patients and meet surgeons’ needs. Our intellectual property is a critical component in making such advancements possible and we are committed to protecting it,” Matthew Lyons, Extremity Medical Chief Executive Officer, Founder and Chairman of the Board About Extremity Medical, LLC Extremity Medical, was founded in 2008, and is a privately-held medical device company based in Parsippany, NJ. The company is known for creating innovative implants and instruments for upper and lower extremity orthopedic procedures, including fusion and motion preservation. The company is focused on developing solutions for challenging cases that promote better outcomes, especially in patients with poor bone quality.

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HEALTH TECHNOLOGY

Komodo Health Introduces New Scientific Publications Management Software

Komodo Health | May 12, 2022

Komodo Health announced the launch of Komodo Publications Planning, introducing the next generation of publications planning and management applications for Life Sciences. The automated and highly customizable end-to-end software is designed to make it easier to maximize the impact and outcome of scientific publications and medical communications in an accurate, efficient, and compliant manner. With today’s news, Komodo extends the power of its real-world data and technology for Medical Affairs professionals, offering a comprehensive suite of applications to manage all aspects of publications planning, including a more data-driven approach to engaging with healthcare providers. In order to establish scientific integrity aligned to strategic medical objectives, global Medical Affairs teams are responsible for managing complex publication plans within Life Sciences companies, which can include both pipeline and commercial products or therapeutics with overlapping timelines. Multiple stakeholders need to seamlessly collaborate, provide feedback, and share updates with one another throughout the process, from publication concept through planning, and ultimately, publishing. With out-of-the-box connectors to Altmetric, Office 365, Unpaywall, and the ability to seamlessly integrate and optimize existing technology workflows, Komodo Publications Planning provides the tools to address every aspect of planning, execution, and analysis in a consolidated view to bring speed and ease for Medical Affairs teams. The integrated, user-friendly workflow enhances productivity by helping customers reduce time spent managing tasks to allow more time to focus on producing high-quality publications. For example, Pfizer was seeking a way to evolve and digitize how its publications were managed. The company developed a customized tool with Komodo Publications Planning as its foundation, which allowed Pfizer to roll out one cohesive publications management system that could be leveraged by a variety of stakeholders around the globe, creating a more efficient path for collaborating with authors and third-party agencies. With a consolidated view into its medical and scientific publication plans, Pfizer’s global team can automate the planning process, quickly tracking publication milestones and monitoring study progression using real-time alerts. “Working in partnership with Komodo on designing and building a new publications management system has been an exciting and courageous journey. We were able to realize some of the innovative solutions we wanted to incorporate into our system to advance our publications practice,” Catherine Skobe, MPH, Sr. Director, Publications Innovative Solutions Lead at Pfizer “Legacy publications management applications often require long build cycles and offer limited control; Komodo Publications Planning is helping our customers eliminate the need for multiple, disjointed systems, which often cause timely and costly delays for publishing critical clinical advancements,” said Prasad Kanumury (PK), Mavens founder and General Manager at Komodo Health. “The ability to integrate into existing IT infrastructure is helping Medical Affairs teams to more effectively achieve their scientific objectives and produce timely, journal-accepted publications within a single, customizable solution.” Stemming from the 2021 acquisition, Mavens' integration into Komodo has resulted in a number of new opportunities for enterprise impact. The release of Komodo Publications Planning marks the first new application within Komodo’s Medical Affairs Suite. The Medical Affairs Suite offers end-to-end workflow support on everything from optimizing publications, impact reporting, and clinical education to enabling HCPs with disease burden intelligence and advanced analytic solutions to build comprehensive, measurable, and evidence-based strategies. The suite also allows for strategic engagement opportunities through key expert identification within Komodo’s Aperture application, now with Medical Information Cloud integration, to encourage even more timely, compliant, and trackable clinical interactions. The launch of Komodo Publications Planning coincides with the 18th Annual ISMPP Meeting, where experts from Komodo Health and Pfizer presented about the future evolution of the medical publications ecosystem in a session on May 9th. For more information, visit Komodo Health onsite at booth #14. About Komodo Health Komodo Health is a technology platform company creating the new standard for real-world data and analytics by pairing the industry’s most complete view of patient encounters with enterprise software and machine learning that connects the dots between individual patient journeys and large-scale health outcomes. Across Life Sciences, payer, provider, and developers, we help our customers unearth patient-centric insights at scale — marrying clinical data with advanced algorithms and AI-powered software solutions to inform decision making, close gaps in care, address disease burden, and help the enterprise create a more cost-effective, value-driven healthcare system.

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The American Health Information Management Association (AHIMA), HIMSS and Integrating the Healthcare Enterprise (IHE) International published “Health IT Standards for Health Information Management Practices,”

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